FOR 'NSTRUCT'OA'S.

SEEMANUAL

--..
DISCLOSURE F#gE. n ;:b.if .-
SUMMARY,
IF*iHrt,.lrA*
FoRcouNwcANDTDATE5 For offlco urc ontr
Gomm-No.--
fnder€d L\L//
CANDIDATSS COMUITTEE NAIIE MustDesameas

/e, t '$#f, HF
oi*"tff
?+l,tI'Eu
tz-7?z-79
ponon flllng lhle r€potl)' TELEPHONE DATESIGNED

GAUTION: PenaltleeDue For Late Flled Reporb Range From $10 to $400

REPORTINGDATES- ELECTIONYEAR BEPORTINGDATES - NONELECTIONYEAR

ReporlDue . CoveredPerlod Beport Due Covered Perlod
tl May20,19- Jan. 1 - May15,19-
tr July20,19 May16- July15,19- Jan.1- Dec.31,193-Z-
tr Oct.20,19- July 16- Oct.15,19-
E Jan.20,19- OsL16- Dec.31,19- CARROLL
COIJNIY

tr Check if Amendmentto report dated JAfil| 7 liitr

tr Gheck if finaf (termination) report. (Attach Notlce ol DlssolutlonForm DR-9)
a.)4
.
STATEIIENT OF CASH ON HAND nnilrtt\/

CASH ON HAND at the beginning ot the reporting period. flhls le the total ot all
monies held by the committee. This amount ilUST be the same aa the cash
on hand at the end of the last rportlng period, 9r must be zero It thls astlrst
report flled) 2, t4/. o7
ADD TOTAL TIONETTAKEN IN THIS PERIOD -o-
ScheduleA: CashContributionstotal (AttachScheduleA) .........
-c7-
Eventstotal(Attachschedulec) ...
schedulec: Fundraising
ScheduleF: LoansReceivedtotal (AttachScheduteD ....
SUB.TOTAL
SUBTRACTTOTAL IIONEY SPENTTHIS PERIOD -o*
Schedule B: Expenditurestotal (Attach Schedule B) ....
ScheduleF: Loan Repaymentstotal (AttachScheduleR ....
CASH ON HAND at thg snd ot this reportlngpedod(lf flnal report balancemustbe zerol
(Attach DB-3, . $ 2, /.//. 6-

UNPAID BILLS (From SchEduleD - Attach Schedule D)

lN KIND CONTRIBUTIONS(From Schedule E - Attach Schedule E)
OUTSTANDINGLOANS (From Schedule F-Attach Schedule F)
CONSULTANTBREAKDOWN(ScheduleG attached?)
-o-
EOUIPmENTPURCHASEDINVENTOBY(ScheduleH)

'REIIINDEB: Tha law placec rceponelblllty rolely upon the candldate tor the llmellness and accuracy ot rcportr tlled by
lhe commltlee treasut€e

r.{}{ItrI7ICPK{ITia,
(Bev.1992)